..X Y & Z
so often, you’d think we’d be used to it by now.
Company X announces
Product Y, a treatment for Condition Z, a problem that’s baffled
the best minds in science for years.
The media jumps
on Product Y’s bandwagon, accentuating positives, eliminating
negatives, and generally rhapsodizing about how great it’s going
to be without Z around, messing up all our lives. Sales
skyrocket, caution is thrown to the wind, and everyone basically
hopes for the best.
If so, the rest of the story should, too.
A report is published, linking Y to Side Effects A, B, and C.
The media weighs in again, now clucking that the early euphoria
was premature, and declaring that a closer, careful look at Y
is clearly in order.
groups leap into the fray. They petition the U.S. Food and Drug
Administration for [take your pick] new controls/warning labels/an
outright ban. They charge that X rushed Y into release without
sufficient concern for possible problems.
The first lawsuits
are filed. Attorneys for Ms. Q or Mr. E file $100 million liability
suits, alleging that X knew all along that Y was dangerous, and
pressed on in a callous display of greed to bring a bad product
to a gullible market.
More time passes.
The public is confused. Is Y still a cure for Z or a deadly rip-off
that causes A, B, and C?
If the above
scenario sounds absurd, it is. But it’s often more fact than
And it certainly
covers most of the public perceptions about Prozac® over
its first decade as blues-busting antidepressant Numero Uno.
raves early on, due to its effectiveness in undoing depression
and other problems.
Later, it started
getting hammered by critics who charged that it causes a range
of adverse effects, even suicide and other acts of violence.
It is. That’s one reason that a closer, careful look at Prozac
— and the expanding universe of antidepressant drugs like it
— clearly is in order.
fact is that both views have at least a little truth in them.
And that’s what makes sorting things out such a challenge —
and so necessary.
..What is Prozac?
Prozac is an
example of a new class of drugs used to treat depression and
other emotional problems. Its chemical name is fluoxetine.
1987, Prozac turned heads from the start, both literally and
figuratively. In the process, it became the most popular antidepressant
in the United States (14 million Americans have used it so far)
and one of the most talked-about drugs in the world.
In fact, for
a time, Prozac seemed more than just a drug. It was a cultural
phenomenon, the subject of an intense media fascination that
played itself out on magazine covers and TV talk shows and best-seller
lists for years, and an equally intense (and prolonged) debate
into the ethics of using drugs to change our feelings the way
we once could only change our underwear.
proved so profitable for its manufacturer that it inspired a
frenzy of interest in the pharmaceutical industry to develop
chemicals like it. The result has been a tide of new act-alike
drugs (including Paxil®, Zoloft®, and others), known
collectively as selective serotonin reuptake inhibitors — SSRI’s,
traditional antidepressants — including tricyclic antidepressants
(TCA’s) and monoamine oxidase inhibitors (MAOI’s) — in some
ways, SSRI’s differ in the way they actually work in the body.
..How do they work?
the action of a specific set of neurotransmitters, chemicals
involved in the transfer of signals from cell to cell in the
central nervous system.
SSRI’s increase the supply of serotonin, a neurotransmitter that
figures into mood, pain, sleep, and a variety other body/brain
They do that
by blocking removal of serotonin from its receptors in the brain.
By stopping these receptors from “turning off” serotonin,
Prozac and drugs like it permit more of the transmitter to be
available at the synapse, the gap between nerve cells.
no one fully understands, this simple biochemical change often
results in improved mood.
How are SSRI’s different from other antidepressants?
affect more body systems — and cause more potential problems
in the process.
example, interact with other neurotransmitter systems. Like Prozac,
they boost serotonin, but also affect another neurotransmitter,
differently. They block monoamine oxidase, an enzyme that breaks
down other neurotransmitters in addition to serotonin.
MAOI’s and TCA’s all reduce depression. And also like Prozac,
no one really knows why they work — only that they usually do
work, probably by increasing the available supply of serotonin.
..Which is better?
on who you ask.
the Public Citizen Health Research Group, a Washington-based
consumer health advocacy group, Prozac works well but is “somewhat
less effective” than a common tricyclic, imipramine.
Prozac and the SSRI’s higher marks, claiming that the drugs can
trigger transformations of self so total that some users say
they “feel like [themselves] for the first time” in
their lives — which raises profound questions about who we are
and how we know for sure.
the biggest boosters of SSRI’s acknowledge they only work about
60-70 percent of the time — the same as other antidepressants.
But even if
the new drugs don’t always work better, they are usually safer
than older antidepressants.
In fact, earlier
drugs caused so many side effects that many users were unable
to stay on them long enough to derive any real benefit.
side effects, too, but they’re usually milder and more manageable.
..What sort of side effects?
on the drug, but common initial problems often include nervousness
and insomnia, or drowsiness and fatigue. Skin rash, nausea, and
diarrhea also occur.
An effect common
to many SSRI’s is some degree of sexual dysfunction — ranging
from an inability to achieve orgasm all the way to a complete
loss of interest in sex. Some researchers guess the rate of SSRI-related
sexual impairment at up to 50 percent.
The risk of
other problems is low, but real. In fact, Prozac’s manufacturer
admits that 15 percent of all patients receiving Prozac in pre-release
trials stopped taking it due to adverse reactions.
therapists (and most of their patients) think SSRI’s stack up
pretty well against the competition, since both TCA’s and MAOI’s
can cause weight gain, changes in blood pressure and heart beat,
constipation, and blurred vision.
look better still when you add in some of their “good”
..What ‘good’ side effects?
One of the
SSRI’s “best” side effects — or, at least, most users’
favorite — is appetite reduction and weight loss. In fact, that
was a big reason that Prozac found fame so fast.
In one study,
65 percent of Prozac users lost at least a pound during a six-week
And two tests
involving subjects who were overweight but not depressed made
Prozac (and presumably the subjects) look even better, with an
average loss of 10 pounds over 8 weeks.
On the other
hand, Prozac doesn’t fight fat for everyone. In fact, underweight
people tend to gain weight while on the drug. And although researchers
aren’t sure why, they suspect it’s linked to Prozac’s effects
on serotonin and its role in appetite control.
..Do SSRI’s help with other problems?
As a matter
of fact, they do. They’ve been tried with varying degrees of
success against a variety of other problems, including obsessive-compulsive
disorder, panic, eating disorders, Tourette’s syndrome, borderline
personality disorder, and schizophrenia.
is needed, but results thus far have advanced the view that there
may well be a single biochemical basis for these and other mental
health problems — and reinforced researchers’ determination
to prove it.
And for the
present, evidence strongly suggests that the common link is serotonin.
If all the
“wonder drugs” that have appeared in recent years,
none has excited more interest or created more controversy than
Prozac and the new antidepressants that have bubbled up in its
be surprising. If a drug is effective enough to attract
major notice when it’s released, it’s probably powerful enough
to generate a backlash.
been the case here.
The fact is
that Prozac is a powerful drug that operates at a deep level
of the brain to correct a biochemical imbalance that not only
seems to underlie depression, but a variety of other body/mind
problems as well.
Does it work?
It seems to, for most people who take it as directed. Still,
everyone who uses it or a drug like it should be aware of potential
side effects and notify their physician of problems immediately
— particularly if the depression worsens or they begin to
The fact is
that the new SSRI’s have produced amazing results for many users.
But that shouldn’t obscure the fact that others have had problems
keeping in mind as we consider Prozac’s risks and benefits and
weigh its pros and cons.
though Prozac is a wonder drug in many ways, it’s also a wonder
how easily we forget that it — and drugs like it — can cause
problems as easily as they take them away.
..Sidebar | Brave
New Drugs: Downside Guide
|high blood pressure
slight (.4%) risk of seizures
..Sidebar | Violence
& Prozac: Is there a Connection?
initial response to Prozac was mostly euphoric, rumors have swirled
around it since the early years, alleging a fearful, dark side
to the drug, including incidents of murder and suicide by users.
At times, the
rumors have even seemed a roar as ex-users came forward with
charges that Prozac caused violent or suicidal impulses — a
process helped along by critics in the Church of Scientology,
which has coordinated an anti-Prozac information campaign as
a part of its larger goal of discrediting psychiatry in general
and psychiatric drugs in particular.
And while the
furor may have died down, for many people the question still
remains: Does Prozac ever cause violence or suicide?
is complex, but the best answer seems to be no, according to
the U.S. Food and Drug Administration.
The FDA points
out that all antidepressants can cause a level of arousal that
can be disorienting, at first. And these feelings usually do
emerge before the full antidepressant effects of the drug kick
in, and could conceivably push a depressed user past the line
that separates self-preservation from self-destruction.
Prozac advocates claim, the documented risk of suicide is greater
with tricyclics — and even with placebos — than it is with
Prozac. And the highest known suicide risk factor of all is untreated
The best solution,
according to experts, is educating patients about possible side
effects and maintaining close communication with the prescribing
physician to reduce the risk of side effects ever getting out